Suicide is not always a tragedy, sometimes it is a choice

When the hospital treating Jacqueline Kennedy’s cancer said they could do no more for her, she went home and gathered around her relatives and friends who were important to her.

One by one, sometimes two by two, they went to her bedside, spent quiet time with her and, before leaving, were given a keepsake by which to remember her. At the end of that day, her son, her daughter and the man who had loved her for many years, were with her when she died.

It was a beautiful, dignified death. The sort of death nobody calls suicide. The sort of death which undoubtedly WAS suicide.

Another beautiful death was that of Martha Gellhorn, the war correspondent, who spent a good chunk of her life trying to avoid being categorised as the 'former wife of Ernest Hemingway'. In later life, Gellhorn was bothered by her own observation of her failing faculties.

"I have no grasp of time and no control over my memory," she wrote in her eighty-sixth year. "I cannot order it to deliver. Unexpectedly, it flings up pictures, disconnected with no before or after. It makes me feel a fool. What is the use in having lived so long, travelled so widely, listened and looked so hard, if in the end you don't know what you know?"

Long before her memory began to act up, Gellhorn had talked of her desire to control her own death, so it was done neatly and efficiently, in a manner and at a time of her own choosing. None of this was a 'cry for help'. On the contrary, Gellhorn didn't want help. In life, she had been social but independent. In planning her death, she was private and independent. She took the steps to suicide tranquilly and on her own.

Over a period of weeks, she wrote to the people the many people she loved and who loved her in return. She sent them treasured personal items which were likely to give them pleasure. She completed a will taking care of her adopted son and making bequests to others for whom she had a fondness.

Then, at a weekend, she showered, got into a clean nightie, swallowed a large number of pills, and read a favourite book until sleep took over and surrendered her to death.

The deaths of Kennedy and Gellhorn contradict the popular fallacy that suicide is the preserve of depressed young men. It isn't.

Not only do people aged sixty-five and older set out to take their own lives more frequently than do people in their teens and twenties; they are also much more likely to succeed. The Director of the oldest suicide prevention volunteer hotline in the United States suggests older suicides tend to be 'completers' rather than 'attempters' because "they've had plenty of time to think about it. They're not impulsive. They have greater access to the means. And they're deadly serious".

"Greater access to the means" is a curious one. In America, it means access to firearms. Older men in America tend to prefer guns over other methods of self-killing. Older women go for pills. In addition, a significant number of self-occasioned deaths are effected by self-starvation or by ceasing to obey a doctor's orders. If someone with dangerously high blood pressure stops taking the tablets, the odds are high that a stroke will result. It's a passive form of suicide.

Clearly, some of these 'silent suicides' come about because of loneliness, depression and desperation. Economic pressure is a cause, too, although there has been a significant reduction in suicides among older people since the thirties, arguing that Old Age Pensions and other provisions against penury among pensioners may have greatly reduced that reason for doing away with yourself.

If the state can prevent suicide by providing social services, then of course the state should provide those services. If the medical profession can prevent suicide by sensitive patient-observation and anti-depressant therapy, then of course this should happen. If the community can prevent suicide by reducing loneliness and isolation among older people, then the community has a duty to do precisely that.

But the imperative of preventing needless and miserable suicides should not stop us acknowledging that some suicides are a dignified expression of individual freedom and a legitimate preemptive strike against something worse. They can be a serene, if not joyful, last expression of the personal competence which has made an individual productive, contributory and happy throughout their life. They show someone taking charge of their death with determination and clarity.

IT is arrogant to assume that a bit of chat, a prescription for Zoloft or verbal reassurances will prevent such suicides. They won't. Martha Gellhorn's death, like that of film star George Sanders, (who left a note mildly observing that he was bored and had lived enough) was of a type identified by Professor of Psychology David Lester as stemming 'from a sense of alienation, when a person loses his sense of continuity and participation in the succession of human generations'. You can't be reassured into a sense of participation in the march of humanity if you're bright enough to realise you're actually no longer part of it.

The widespread conviction is that suicide is always a tragedy derives from much-publicised suicides, usually of the young. Each of us knows a family shattered by the death of a son or daughter on the cusp of adulthood. We remember the death of Kurt Cobain as a sad destruction of talent. We remember the death of Sylvia Plath (depending on our prejudices) as the result of long-standing depression or a desire to punish her unfaithful husband.

Adding all of that together generates a view of suicide as always and inescapably catastrophic. It isn't.

When, in a discussion with friends recently, I mentioned that I had built up a stack of Mickey Finns sufficient for hypothetical suicide, the responses ranged from horror to medical reassurance to religious outrage.

The horrified friends pointed out that I'm cheerful by nature, have come through my share of physical trauma and have nothing major wrong with me, at least in health terms.

(Which is a bit like saying to someone "You're in the kitchen having a cup of coffee, so what's the point of insuring yourself to drive a car?" Circumstances change, you know. It's one of their annoying characteristics.)

The medical reassurers promised me that these days, between the hospice movement and the medical profession, no pain is unreachable and unfixable. Maybe, maybe not. But the best analgesia in the world doesn't make an intubated, ventilated, brightly lit clinical death among solicitous strangers compare with a demise like that of Jacqueline Kennedy.

My religious friends, aghast, said "You wouldn't, would you?" Answer: how do I know what I will feel, fear or believe in, twenty or thirty years hence? If, at that point, I believe God would put me in the fifth circle of hell for suicide, I'm unlikely to do it. However, there's also the chance that at that point I might believe more than anything else in Martha Gellhorn's rhetorical question:

"Why stay until the evil present becomes a worse future and eats away all the value of the past?"

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